Living close to tobacco sellers linked to reduced odds of quitting

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Increase in distance from residence to retail tobacco outlet was associated with greater likelihood of smoking cessation among smokers in two large longitudinal Finnish studies.

Note that among ex-smokers, distance to the nearest tobacco outlet was not associated with relapse.

Living in close proximity to retail establishments that sell tobacco products appears to make it harder for smokers to kick the habit, according to a longitudinal analysis of data from two large studies conducted in Finland.

Each 500-meter increase in distance from home to the nearest tobacco outlet was associated with a 16% increase in odds of quitting smoking in adjusted between-individual analysis (pooled odds ratio 1.16; 95% CI 1.05 to 1.28) and a 57% increase in within-individual analysis (pooled odds ratio 1.57; 95% CI 1.32 to 1.86).

Change in distance to the nearest store selling tobacco products did not appear to influence smoking behaviors among ex-smokers.

The study is the first of its kind to examine the impact of residential proximity to tobacco sales on smoking behaviors, and the findings have important policy implications for smoking cessation efforts, researcher Anna Pulakka, PhD, of Finland's University of Turku, and colleagues wrote online in JAMA Internal Medicine.

"We found robust evidence suggesting that among Finnish adults who smoked, increase in the distance from home to a tobacco outlet increased the odds of quitting smoking," the researchers wrote.

They added that smoking cessation efforts should consider initiatives aimed at reducing the number of retail establishments that sell tobacco, such as banning sales near schools or offering incentives to get retailers to stop selling the products.

"We can now conclude that tobacco outlets and the heavy dose of tobacco marketing they dump into their communities cause smoking -- more precisely, they inhibit quitting among smokers," they wrote.

The analysis included data from two prospective cohort studies conducted in Finland that had information on geocoded residential addresses, addresses of tobacco outlets, and responses to smoking surveys in 2008 and 2012 (the Finnish Public Sector [FPS] study) or 2003 and 2012 (the Health and Social Support [HeSSup] study).

At study entry, all participants were either smokers or ex-smokers. The researchers used logistic regression in between-individual analyses and conditional logistic regression in case-crossover design analyses to examine change in walking distance from home to the nearest tobacco outlet as a predictor of quitting smoking in smokers and smoking relapse in ex-smokers. Fixed-effect meta-analysis was used to pool study-specific estimates.

The final analysis included 20,729 participants, including 6,259 current smokers at baseline in one study and 1,090 in another.

Findings from the smoking behavior surveys conducted 4 to 9 years apart revealed that 28% and 39% of smokers had quit and 7% and 6% of ex-smokers had relapsed in the FPS and HeSSup studies, respectively.

"Among the baseline smokers, a 500 meter increase in distance from home to the nearest tobacco outlet was associated with a 16% increase in odds of quitting smoking and 57% increase in within-individual analysis after adjusting for changes in self-reported marital and working status, substantial worsening of financial situation, illness in the family, and own health status," the researchers wrote.

"It is time to recognize the risks that tobacco retail outlets pose to communities," Farley and Bettigole argued in their commentary. "A child living in North Philadelphia who walks three-quarters of a mile to a middle school can pass as many as 16 stores selling cigarettes en route. That represents 16 sales pitches every school day for an addictive drug that is the nation's biggest killer."

Farley and Bettigole concluded that "it is now painfully clear that Big Tobacco, by redirecting its massive marketing budget to retail stores, has hit upon a strategy that works."

"The Marlboro Man no longer rides on television and radio, but point-of-sale substitutes -- price discounts, coupons, advertisements and a barrage of other retailer promotions -- can be nearly as effective," they wrote. "Those of us who care about the health of the nation must redesign our anti-smoking strategy to confront this danger."

This research was funded by the Academy of Finland.

The researchers declared no relevant relationships with industry related to this study.

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